内科

目的探讨龈下刮治和根面平整术对老年冠心病合并牙周炎患者血脂、血清和龈沟液肿瘤坏死因子（TNF-α）、基质金属蛋白酶-8（MMP-8）、单核细胞趋化蛋白-1（MCP-1）的影响。方法选择2016年2月至2017年5月在我院诊治的老年冠心病合并牙周炎患者68例，按随机数字表法分成对照组和观察组，每组34例。对照组患者给予常规冠心病治疗，观察组在常规冠心病治疗的基础上给予龈下刮治和根面平整术治疗。比较两组患者牙周菌斑指数（PI）、探诊深度（PD）、探诊出血（BOP）及临床附着水平（CAL）；检测比较两组患者的甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白(HDL-C) 、低密度脂蛋白(LDL-C)水平；检测比较两组患者血清和龈沟液TNF-α、MMP-8、MCP-1水平。结果治疗后6个月，观察组患者的PI、PD、BOP、CAL显著改善，并且显著优于对照组（P＜0.01）；观察组患者的TG、TC、 LDL-C水平显著降低、HDL-C水平显著升高，TG、TC、 LDL-C水平显著低于对照组、HDL-C水平显著高于对照组，差异有统计学意义（P＜0.05）；观察组血清TNF-α、MMP-8水平显著降低，并且显著低于对照组，差异有统计学意义（P＜0.05）；观察组患者龈沟液TNF-α、MMP-8、MCP-1水平均显著降低，并且显著低于对照组，差异有统计学意义（P＜0.05）。结论龈下刮治和根面平整术治疗老年冠心病合并牙周炎患者，能有效改善患者牙周组织生理状况，降低血脂，降低血清TNF-α、MMP-8水平，降低龈沟液TNF-α、MMP-8、MCP-1水平，有利于冠心病的治疗。

ObjectiveTo investigate the effects of subgingival scaling and root planing on serum lipids, tumor necrosis factor (TNF-alpha), matrix metalloproteinase 8 (MMP-8), monocyte chemoattractant protein-1 (MCP-1) of serum and gingival crevicular fluid in patients with coronary heart disease and periodontitis. Methods68 elderly patients with coronary heart disease and periodontitis from February 2016 to May 2017 were selected， They were divided into the control group and the observation group according to the random number table method, 34 cases in each group. The control group were treated with conventional coronary heart disease, while the observation group received subgingival scaling and root planing on the basis of conventional coronary heart disease treatment. The periodontal plaque index (PI), diagnostic depth (PD), detective bleeding (BOP) and clinical attachment level (CAL) were compared between the two groups, and the levels of serum triglyceride (TG), total cholesterol (TC), high density lipoprotein (HDL-C) and low density lipoprotein (LDL-C) in the two groups were compared. Serum levels of TNF-alpha, MMP-8 and MCP-1 in serum and gingival crevicular fluid were compared between the two groups. ResultsAfter 6 months treatment, the PI, PD, BOP and CAL of the observation group were significantly improved. It was significantly better than that of the control group (P＜0.01). The level of TG, TC and LDL-C in the observation group decreased significantly and the level of HDL-C increased significantly. The level of TG, TC and LDL-C was lower than that of the control group and the level of HDL-C was higher than that of the control group, the difference was statistically significant (P＜0.05). The serum levels of TNF-and MMP-8 in the observation group were lower than those in the control group (P＜0.05). The levels of TNF-alpha, MMP-8 and MCP-1 in gingival crevicular fluid of the observation group were lower than those of the control group, and the difference was statistically significant (P＜0.05). ConclusionSubgingival curettage and root surface leveling in the treatment of elderly patients with coronary heart disease combined with periodontitis can effectively improve the periodontal tissue physiological status of the patients, reduce blood lipid, reduce the level of serum TNF-alpha and MMP-8, reduce the level of TNF-a, MMP-8 and MCP-1 in gingival crevicular fluid, which is beneficial to the treatment of coronary heart disease.